Sunday, January 16, 2005

Unless the state increases reimbursement rates on dental programs for the needy, more dentists likely will opt out on accepting new patients under the programs.

Wisconsin ranks in the bottom five states nationwide in reimbursement rates for subsidized dental care, said Fred Jaeger, president of the Wisconsin Dental Association.

One of the Green Bay area’s largest providers of subsidized dental care, Dental Associates, announced this week it no longer will take new patients who are on BadgerCare or Medical Assistance.

The company said it is losing money because reimbursement rates from the state are too low in those programs.

“It’s become more difficult over the years because of low reimbursement, and now we’re losing money,” said Anthony Vastardis, chief executive officer of Dental Associates. “We felt we had to close the door to new ones, though we will continue to provide service to existing patients in the programs.”

Vastardis said Dental Associates has close to 14,000 subsidized-care patients in the Green Bay area. “Those people will continue to get service,” he said.

Wisconsin reimburses about 40 percent of the cost for such dental care and is expected to reimburse 38 percent in 2005.

Vastardis said Dental Associates can’t afford to continue being reimbursed $26 for a tooth cleaning by a hygienist who gets $30 an hour.

“That rate doesn’t cover the staff salary, or lights and heat in the office,” Jaeger said.

The Wisconsin Dental Association wants the state to reimburse dentists to the 75th percentile, meaning the state would pay 75 percent of dentists 100 percent of their costs. But the state has declined to do so because it would double the amount of funding needed. The state now pays about $30 million a year to cover dental costs for Medical Assistance patients.

About 92 percent of the 2,842 dentists practicing in Wisconsin who responded to a 2001 state survey said they accepted new patients, but only 19 percent said they took new Medicaid and BadgerCare clients. However, about 40 percent said they have existing Medicaid and BadgerCare clients.

BadgerCare, the state’s health-insurance program for the working poor, enrolls more than 121,000 Wisconsin adults and children.

The state needs to re-examine who gets services and allocate limited funds to those most in need, Vastardis said. That could mean offering comprehensive dental care for youths younger than 21 and limiting adult care to emergency services, he said.